A 58-year old woman presented with constant epigastric abdominal
pain radiating to her back, of 1 week’s duration. The patient had
associated nausea, vomiting, anorexia, and weight loss. Physical examination
revealed midepigastric tenderness without a palpable mass. Pertinent laboratory
values included serum amylase of 410 units/L and lipase of 471 units/L.
Abdominal computed tomography (CT) scan revealed a 6-cm cystic mass
between the stomach and pancreas, as well as mild pancreatitis ([Fig. 1]). Upper endoscopy showed extrinsic
compression of the stomach along the lesser curvature, prohibiting passage of
the scope to the pylorus. Endoscopic ultrasound revealed a
6 × 6-cm heterogeneous, well-rounded mass with
calcifications and a calcified rim originating from the gastric mucosa, along
with upstream dilation of the pancreatic duct to 1 cm ([Fig. 2]). Fine-needle aspiration revealed spindle
cells. During surgery, a well-rounded mass originating from the gastric antrum
was found to have prolapsed into the second portion of the duodenum,
obstructing the pancreatic duct. The patient underwent a partial resection of
the anterior gastric wall. Final surgical pathology revealed diffuse c-kit
positivity, confirming the mass was a gastrointestinal stromal tumor (GIST).
Postoperatively, the patient’s pancreatitis resolved, and she has not had
a recurrence of her pancreatitis.
Fig. 1 a Gastrointestinal
stromal tumor (GIST) obstructing the pancreatic head, with upstream dilation.
b Prolapsed GIST protruding into the duodenum and
obstructing the pancreatic duct.
Fig. 2 a Endoscopic ultrasound
(linear view) revealing a 6 × 6-cm gastrointestinal stromal
tumor (GIST). b Endoscopic ultrasound (linear view)
revealing GIST-induced dilatation of the pancreatic duct to 1 cm.
Although there are reports of duodenal GISTs mimicking pancreatic
cancer, there are no known reports where acute pancreatitis (fulfilling two of
three criteria) is secondary to a GIST [1]. In
conclusion, we report a rare case of gastrointestinal stromal tumor presenting
as acute pancreatitis, which, to our knowledge, is the first reported case in
the literature.
Endoscopy_UCTN_Code_CCL_1AB_2AD_3AB
